04-1020_ALEXANDER ENGINEERS, INC._Insurance CertificateAt CVA=KNM-1
wlenw.-
�OB12e CERTIFICA
_ OF LIABILITY
INSU. NCE ioizoo °"Y'
PRODUCER _
Dealey, Renton &Associates
De S Los Robles Ave Ste es ' '
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,� '- I`' i��;i II
s J _VI
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- THIS" CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY'; AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
POLICY NUMBER
INSURERS AFFORDING COVERAGE —
- -
Pasadena, CA 91101
626 844-30702j.
_ -_
INSURED
Alexander Engineers, Inc.
(l
_ _
_
INSURER United States Fldellty $ GUafaDty .
LRER St. Paul Fire & Marine Ins. Co.
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502 W. Route 66, Suite 17
P VNlCnK3
INSURER
Great American Assurance Co.
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.I RER 0
--—
IBO
Glendora, CA 91740 .. -... -. .......__..:
OAMAGE(my one fire)
$1 000000
INSURER E:
X COMM ERCIAL GENERALLIABILITY
GVVCnMVCD
INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING
THE POLICIES OF
OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR
ANY REQUIREMENT, TERM OR CONDITION
MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR
—�
TYPE OF
POLICY NUMBER
POLICY EFFECTIVE
DATE MMA)D/YY
POLICY EXPIRATION
DATE M D/YY
LIMITS
LTR
A
GENERAL LIABILITY
BKO1226262
10/16/04
10116/05
OCCURRENCE
tFIRE
$1 000 000
OAMAGE(my one fire)
$1 000000
X COMM ERCIAL GENERALLIABILITY
MED EXP (Any one person)
$10000
CLAIMS MADE E OCCUR
PERSONAL &ADV INJURY
$1,000,000
GENERAL AGGREGATE
52 000 OOO
PRODUCTS-COMP/OPAGG
$2000000
GEN'L AGGREGATE LIM IT APPLIES PER:
POLICYE7 LOC
A
AUTOMOBILE
LIABILITY
BKO1226262
10/16/04
1O/16/05
COMBINED SINGLE LIMIT
$
(Ea accident)
ANY AUTO
ALL OWNED AUTOS
BODILY
$1,000,000
(Pererparson)
Persw)
SCHEDULED AUTOS
——
X
BODILY INJURY
52,000,000
HIREDAUTOS
(Per accidem)
NON -OWNED AUTOS
--
FX
II
PROPERTY DAMAGE
$
(Per accident)
GARAGE LIABILITY
AUTO ONLY - EAACCIDENT
$
OTHER THAN EA ACC
ANY AUTO
$
AUTO ONLY: AGG
$
EXCESS LIABILITY
EACH OCCURRENCE
$
AGGREGATE
$
OCCUR F-� CLAIMS MADE
$ —
DEDUCTIBLE
---
S
RETENTION $
B
WORKERSCOMPENSATION AND
WVA7724714
09101104
09/01/05
WC STATU- OTH-
X TORY LMAiTS I_
_—
I E.L EACH ACCIDENT
B
EMPLOYEP.S'LIASILITY
$1,000,000
E.L. DISEASE - EA EMPLOYEE
0,000,000 _
E.L. DISEASE - POLICY LIMIT
$1,000,000
C
OTHER Professional
JEDN5850421
10/16104
10/16/05
$1,000,000 per claim
lability
$1,000,000 annl aggr.
DESCRIPTION OF OPERATONS40CATWlSIVEMCLESIEXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
The City of San Juan Capistrano is named as an additional Insured as
respects general liability for claims arising from the operations of the
named insured.
City of San Juan Capistrano
Public Works Director
32400 Paseo Adelanto
San Juan Capistrano, CA 92675
LD ANYDFTHE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORETHE EXPIRATION
THEREOF, THE ISSUING INSURER WILL XXRW %NXIP MAILAO—DAYSWRTTEN
ETOTHE CERTIFICATE HOLDER NAMED TOTHE LEFT, 13038110tAXAAAAM11K 7
1988
Ll
Policy Number: BKO1226262
Owners Lessees or Contractors (Form B)
ADDITIbNAL INSURED
Change(s) Effective: 10/20/04
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT
CAREFULLY. This endorsement modifies insurance policy under the following:
LIABILITY COVERAGE PART:
Schedule
Name of Person or Organization:
City of San Juan Capistrano
Public Works Director
32400 Paseo Adelanto
San Juan Capistrano, CA 92675
SECTION II - WHO IS AN INSURED is amended to include as an insured the
person or organization shown in the Schedule, but only with respect to liability
arising out of "your work" for that insured by or for you.
The City of San Juan Capistrano is named as an additional insured as
respects general liability for claims arising from the operations of
the named insured.
PRIMARY INSURANCE:
IT IS UNDERSTOOD AND AGREED THAT THIS INSURANCE IS PRIMARY
AND ANY OTHER INSURANCE MAINTAINED BY THE ADDITIONAL INSURED
SHALL BE EXCESS ONLY AND NOT CONTRIBUTING WITH THIS
INSURANCE.
CUBF 22 40 03 95
0 0
WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS
This endorsement changes the policy to which it is attached effective on the inception date of the policy unless a different
date is indicated below.
(The following "attaching clause" needs to be completed only when this endorsement is issued subsequent to prep@Mt[QnQf the poltcya_ - .
_. �.
This endorsement forms a part of Policy No. WVA7724714
Issued to: Alexander Engineers, Inc.
By: St. Paul Fire & Marine Ins. Co.
Premium (if any) TBD
We have a right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our
right against the person or organization named in the Schedule. (This agreement applies only to the extent that you
perform work under a written contract that requires you to obtain this agreement from us).
You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work
described in the Schedule.
The additional premium for this endorsement shall be 2-5% of the California workers compensation premium otherwise
due on such remuneration.
Schedule
Person or Organization Job Description
City of San Juan Capistrano
Public Works Director
32400 Paseo Adelanto
San Juan Capistrano, CA 92675
WC 04 03 06 Countersigned by
(Ed. 4-84) Authorized Representative